Costs soar for updating NC's Medicaid computer system

State’s effort to modernize the way it processes Medicaid claims will take nearly a decade, cost almost $900 million.

jneff@newsobserver.comJune 17, 2012 

  • Trouble in New York In 1998, the state of New York hired Computer Services Corporation to design and run a new processing system. The new system came on line in 2005, 33 months late and $166 million over budget, a cost overrun of 47 percent. The state comptroller blamed the delay and cost overrun on both CSC and the state Department of Health. As it built the new system, CSC was also operating the old claims system. The dual roles meant the state was paying CSC for both jobs, giving the company little incentive to bring the new system in a timely manner, according to the comptroller’s office. The comptroller also found that the system was not based on the best technology available at the time and was unable to make timely changes when state or federal laws changed. The problems in New York were not solely the fault of CSC. The comptroller found that the Department of Health provided ineffective oversight and missed opportunities to levy penalties allowed under the contract. The department didn’t have a contingency plan in place, and when it came time in 2006 to negotiate an extension, CSC demanded a three-year extension at a cost increase of 62 percent. The comptroller initially opposed the new contract but relented when CSC said it would stop processing claims.

— In a bland office park off Lake Boone Trail, two computer teams toil away on behalf of the biggest contract in state history – the computer system that processes 88 million Medicaid claims each year.

The 500-plus team of workers from Computer Sciences Corporation, a tech company from northern Virginia, is working to finish the new system by next summer. Upstairs, 200 workers from Hewlett Packard, the technology giant from California, keeps the old 1980s-era system running, receiving, auditing and paying about 250,000 claims each day.

The project has gone in fits and starts since it began in 2004: cancelled and rebid, then amended and extended. Costs have kept rising, so much so that the expense of setting up the new system and running it for seven years, plus maintaining the old system, now adds up to an eye-popping figure: $851 million.

And that’s if it goes on line next summer, as scheduled.

Little in this project has gone as scheduled. The first contractor was dismissed, only $16 million into the work. The second, CSC, is two years behind its original timeline. In the world of information technology, the delays and overruns earn it the title of a “black swan” project.

Most of the delays and cost increases come from changes in federal and state laws and regulations, according to Al Delia, secretary of the state Department of Health and Human Services. He likened it to a home construction project where the owner asks the builder to add a second floor and garage midstream.

“Most of what have been called cost overruns aren’t really cost overruns,” Delia said.

In the long run, state officials say, the new system has the potential to save the state hundreds of millions of dollars. Along with processing claims for Medicaid – the government health care plan for the poor and disabled – the contract requires the system to be able to process claims from other payers, such as the State Health Plan or the state prison system.

“We expect this will be cutting edge, state of the art,” Delia said.

If so, it will be an unusual cutting-edge system: it’s largely written in COBOL, a computer language developed in the 1950s that is scarcely taught in North Carolina – just community colleges in Hickory and Charlotte. CSC has imported workers from India to fill the jobs in Raleigh.

Legislators wonder if state officials will ever be able to get the project finished.

“The $640 million question is, will the Medicaid system operate as billed?” asked state Rep. Nelson Dollar, a Cary Republican who co-chairs a committee that oversees DHHS. “We are skeptical until we see it.”

CSC declined to answer questions, but released a statement saying the project would be completed on time and within budget: “This new system will enable the State to better manage costs, improve healthcare administrative efficiency and enhance customer service for healthcare providers and recipients.... We are focused on delivering a high performance healthcare system that meets the specific needs of North Carolina and its constituents.”

High hopes

In 2003, the state solicited bids to replace the outmoded Medicaid claims system, which had been operated for 35 years by EDS, a Texas company later purchased by Hewlett Packard. Millions of lines of computer code power the program, which accepts claims from some 70,000 providers – doctors, clinics, hospitals, nursing homes and others.

It’s a big business: the Medicaid program will cost nearly $13 billion in North Carolina this year, about 23 percent from state funds and the rest federal. The new system is designed to detect fraud and avoid waste.

Federal tax dollars pay for 90 percent of the design of the new program and half of its operating costs.

There were high hopes in 2004 when the state gave the $171 million contract to Affiliated Computer Systems to replace the 1980s system.

The project “continues to forge ahead with great expectations,” according to a 2005 letter from Angeline Sligh, the director of the project. “It is our goal that this be one of the best replacement implementations in the nation.”

The project soon fell behind, with DHHS officials and ACS arguing over timeline and payments, each blaming the other for the mess. In May 2006, State Chief Information Officer George Bakolia threatened to kill the project unless the two sides could resolve their differences and come up with workable plan. Bakolia demanded new project managers at DHHS and ACS.

In July 2006, the state cancelled the contract, and eventually paid ACS $16.5 million, partly for work, partly to settle a lawsuit.

The state replaced its project managers, who run the program day to day. Their supervisors – Sligh and her boss, Assistant Secretary for Finance Dan Stewart – remained on the job.

An extension, a picnic

Round two began in 2008, when the state awarded a $265 million contract to CSC, with a go-live date of August 2011.

The contract sparked a fierce fight. HP, which runs the 1980s system, was a bidder on the new contract and protested on technical and political grounds: CSC had retained former DHHS Deputy Secretary Lanier Cansler as a lobbyist. Weeks after the contract award, Cansler was named DHHS secretary by Gov. Bev Perdue.

Stewart denied the protest.

In its bid documents, CSC estimated that 90 percent of the millions of lines of computer code needed could be copied from its New York Medicaid program. CSC later revised that to 73 percent; in the end, because of big differences between the New York and North Carolina Medicaid programs, only 32 percent of the New York code was used.

The program soon fell behind, and in the summer of 2010 CSC asked for an extension. Following a lengthy negotiation, the state granted an 18- to 22-month extension and raised the contract price to $495 million.

CSC celebrated the amended contract with an invitation to a July 28, 2011, picnic at Umstead Park: “Please plan to join us for BBQ and Indian Cuisine! It will be a great time to get to know your co-workers as well (as key CSC and DHHS) executives. You might even have the chance to challenge them to a game of bean bag toss or horseshoes!”

Delia, who became DHHS secretary in February, says CSC added six months of delay by overestimating how much code it could bring from New York. The company agreed to pay the state $10 million in damages, an amount criticized as unsubstantiated and low in a subsequent state audit.

The rest of the delay, Delia said, stems from changes in federal and state laws and regulations, and was out of the control of DHHS.

A January report from State Auditor Beth Wood questioned the six-month figure, saying that DHHS did a poor job of documenting how it made key decisions: determining the six-month delay; calculating the damages owed by CSC; and tracking $30 million in unauthorized changes that CSC made in the program.

The audit was contentious from the start. Stewart told Wood that his staff was too busy to answer questions and provide documents. Their cooperation “will, by necessity, be minimal due to the lack of staff time, the urgency to complete the project and the liability related to delaying the IT contractors working on the project.”

The department’s response, twice as long as the audit, disagreed with virtually every paragraph, calling the audit biased, inaccurate, unproductive, ill-informed, unfounded and asinine.

Wood called the audit the most difficult of her career.

“It was the most uncooperative, dragging-the-feet, missing-deadlines audit like I’ve never seen,” she said.

During a hearing in January, legislators looking into the project asked Angie Sligh to grade her management of the contract. She gave herself an A.

Writing in COBOL

The audit did not touch on the fact that the state contracted in 2008 for a program written in COBOL, a computer language written in the 1950s. According to Bakolia, the former state chief information officer, COBOL is used in banking, transportation and federal systems that have been in use for decades, but it is almost never used in new systems.

“If the programs are written well and operate, companies don’t want to rewrite them,” Bakolia said. “If I were to write something today, it would not be COBOL. You can’t support it.”

In North Carolina, classes in COBOL are as popular as 8-track tapes. Wake Tech’s extensive computer science offerings don’t have COBOL, and neither does N.C. State.

Frank Mueller, an N.C. State computer science professor, said the supply of COBOL programmers is dwindling as people retire.

“As a consultant to any company, I would probably advise them against using COBOL,” Mueller said. “The problem is that it’s harder to find someone to change the code. If you change the law, you have to change the code.”

Asked about COBOL in an interview Thursday, Stewart said: “This is the first time I’ve ever heard that question raised.”

To fill the jobs, CSC recruited heavily in India – over half the staff, according to CSC workers who asked to remain anonymous out of fear of being fired. CSC did not respond to questions about foreign workers.

Stewart said he had no idea about the staff makeup.

“I have never seen their staff,” he said.

Delia said it is not an issue.

“It’s a private company, we have no way of knowing,” Delia said. “They are legal workers, it’s kind of a non-question.”

After working through a tough audit, firing a contractor and enduring multiple extensions, state officials have now turned their attention to another participant in the project: their own watchdog.

They are threatening to fire Maximus Inc., the Virginia firm paid to police the project for the state. Maximus, nearing the end of a three-year contract, is paid $1 million a year.

Neff: 919-829-4516

News & Observer is pleased to provide this opportunity to share information, experiences and observations about what's in the news. Some of the comments may be reprinted elsewhere in the site or in the newspaper. We encourage lively, open debate on the issues of the day, and ask that you refrain from profanity, hate speech, personal comments and remarks that are off point. Thank you for taking the time to offer your thoughts.

Commenting FAQs | Terms of Service